Tales from the Emergency Department; in which a man who wallows in nostalgia, and secretly wishes he were a Victorian KnifeMan rants about his work and what passes for a life.
He's heard it might be therapeutic...
Names have been changed to protect the innocent.
Any resemblence to parties alive or dead is purely coincidental

Friday, May 25, 2007

One of the things I like most about my job is the feeling of being part of a team, or a family. I really felt like we were all in it together, when I started on the wards. That feeling was gradually eroded as we started working shifts, and the Nurses started leaving, or rotating.

I found it again in the Emergency Department; the staff pool is relatively fixed - although we all still rotate frequently, so maybe it's me that breaks up the family.

Everytime I move, it takes me a while to settle in, learn how everything works, learn how the people work, And they have to get used to me. Then I can start feeling comfortable again, start feeling at home at work, which is probably a bit sad.

So far, all I seem to do in my new job is flail. I'm making elementary mistakes, and seem to have pissed off at least one member of staff, while convincing the others I'm some sort of bandit medic.

Thursday, May 24, 2007

1. Shroom got his name at Reading Festival 19922. He has at least one other nickname, the origins of which no-one can recall3. I drink faster than I get drunk, always to my own detriment4. I secretly quite like Dire Straits5. My favourite cocktail is a whisky sour6. I spend hours formulating grand plans, then procrastinate about doing them until it's too late7. I once cried watching an episode of Magnum, P.I.8. I quite fancy the idea of sporting a huge 'tache, but am utterly incapable of growing one...

Random enough? I'm not sure.I know I'm supposed to tag another 8 people, but for the now, I'm going to be a killjoy.

Wednesday, May 16, 2007

Midweek blues, and everything that promised so much at the end of last week, seems to be vanishing in a haze.

So: Old jib from Shroom's casebook.

I don't think I've talked about this case before; apologies if I have.

Sometimes, you start with what looks shitty, and it keeps getting worse. I think this is harder to deal with that something that looks bad, and is simply bad. When you deal with someone who looks really bad, and keeps getting worse, all the little promises you make to yourself, to the patient, to their relatives - all those minute fragments of hope you leave out, to keep it flickering, alive - they're all exposed as lies, oh, so quickly.

The start of a shift is bad for this. Especially in a busy Dept. That's when, through no-one's fault stuff slips through the cracks.

I came on to a particularly hectic department. Understaffed, undernursed, just barely keeping their heads above water. First thing I saw was a patient in the 'high - dependency' bay. (It's monitored, and visible from the Nurses / Doctor's station. The trolley was in Trendelenburg. (Head down). Never a good sign.

All about me staff are rushing urgently, all busy doing something... but not for this patient. This is briefly re-assuring; maybe a vaso-vagal? My eyes casually flicked up to the monitor, all at once taking in the profoundly low Blood Pressure and fast heart rate. I remember only then looking at the patient and thinking how young they were. Young and pale. Pale enough to be on one of Shroom's lists.

The history is typical for this sort of thing in Shroom's experience. A young 'un, brought in, walked in, with parent. Innocuous, non-specific history for a few days, finally developing a few sinister symptoms, provoking the visit. People who walk in can't be sick, right.

Bollocks.

Eyeballed by the nurses out front, the patient is rapidly propelled 'round the back', or wherever your major treatment area is. Then something else happens, and they get left... it happens. The one's that don't, don't fulfill this sort of category.

Anyway, we booted this one to resus, and fired up the usual. Large bore access, oxygen, bloods. Fluids, fluids, fluids. Hot as hell, we chuck in broad spectrum antibiotics, and go rash hunting. Meningococcal sepsis finds itself high on my list of 'Diagnoses Not To Miss'. (As well, coincidentally, as my list of 'Illnesses Not To Be Afflicted With'.)

Clinically the picture is of septic shock, in a young patient. But how bad? Try to explain what's going on, serious but not too bleak. Yet.

Slowly, then in a rush, every test I did came back, the patients indices all wildly out of kilter, the case getting more serious by the second, and the response to 'simple' treatment unimpressive.

The source was revealed as a multi-lobar pneumonia. ITU were swiftly involved, and the clever medicines deployed, through big, ugly lines. And every few minutes I had to go back and explain that the situation was a bit worse than before, to unmask my lying optimism, to shred a bit more of he fragmented hope I'd thrown out.

As the patient left, I really thought it was all up. We had done all we could, they would do all that they could; but it wouldn't be enough.

Sunday, May 13, 2007

No medical gib follows. Be warned and stop now if you have no interest in what I got up to in a field this weekend.

Pictures to follow - as usual I took a very expensive camera, and no pics. But plenty of others did, and with luck, thru the magic of digital media...

So, it was the wedding of one of greatest friends this weekend. In fairness, of two of my friends, but the Groom I have known for 20 years, and we've been through a lot of 'formative' shit together (I certainly wouldn't have been a doctor without him), and his fiance - now wife! - I have only known a few years, so although I consider her a dear friend, it is perhaps not the same thing. Whatever.

Thursday saw me at a dance / drama performance, a first for me. A slightly alien media to me. It was interesting, and a good evening, for a variety of reasons. Maybe it could have, or should have gone better. Only time will tell. Anyway, Friday found me pretty pleased with myself. Festivities were due to kick off on Saturday, but as the whole thing was essentially being held in a field (a place called ColdBlow Farm, which I can highly recommend), quite a lot of organisational flail was required. As Best Man, I was in the frame... so after a late night of modern dance / drama, I roused myself from my pit and packed up to deploy to a field in Kent.

My friend has never been even remotely conventional, so this was a fancy dress affair. As I may have mentioned, I was to be Puck. Puck is an interesting character, but not easy to define in terms of costume. I had found a production where Puck was dressed in red furry trousers and blue body paint. This was I had intended to go with, but singularly failed to find any red furry material, and lack the required Adonis like figure to make my torso my costume. Instead I cobbled some black furry trousers together, and paired it with a ruffled shirt, gold cravat and coloured waistcoat. Topped off with pointy ears, horns and some greenery, I just about passed muster. Still, at least I wasn't Bottom.

Lunchtime on Friday found me and the Groom alone on the Farm, drinking beer and shooting the shit. We were supposed to be erecting a marquee, but there was, inevitably, a delay. At some stage, about three beers in, I acquired my first injury of the event. Clinically this appears to be a mild ankle sprain - the bruising and swelling are minimal, but it gave me something to moan about. Eventually the Marquee and PA arrived, and we set everything up. A few pioneers were arriving by this stage, and it was agreed that we'd all have a quiet one, in honour of the big day on the morrow. The best laid plans...

The next morning saw a few die hards drinking on through, and Bottom (the other best man, resplendent in full ears, and a magnificent tail) pinning a nervous groom into his costume of Oberon. We left good and early, since there is always great flail potential in anything involving these guys. Lemons may get the job done, but sometimes it's hard work getting there.

We arrived at the Registry Office in good time, which was handy, as on our arrival, Oberon announced that he'd left the music behind. Despite being accompanied by Wonder Woman, and Zorro, it was left to me to make a madcap dash back to the farm. CD in hand, if you were in Maidstone this weekend, you might have seen a hairy legged hobgoblin scampering breathlessly through the churchyard adjacent to the Archbishop's Palace. 'Twas indeed I. When I got there, with literally minutes to spare, all I could see were regular getting married folks. There followed about a minute of panic while I wondered whether I'd taken a wrong turning, and weighed up the pros and cons of gate crashing a straight laced wedding dressed as Puck, when fortunately I saw our crowd of freaks, flying the flag... and the freak flag flew proper high over Maidstone - I don't think the Registrar had seen the like before, as Oberon and Tatania, Prospero and Queen Mab, Wonder Woman and Zorro, and even the Jolly Green Giant (ho! ho! ho!) all crammed in to celebrate . Fucking brilliant. The Bride and Groom exited to the sounds of Steppenwolf, and were driven away in a Black Pontiac Trans Am. (If this means nothing to you, you're too young)

The Reception was a blast. Fancy dress is indeed hilarious. The weather wasn't brilliant, but wasn't dreadful either. Speeches went off with only a little flail, and much fun was had engaging in jousting and Maypole based antics. Some of our friends had come as the Three Musketeers (which, incidentally, always seems a misnomer to me, as they were renowned for their swordplay, not their musketry) which gave me some concern as they were all wielding proper swords. Sure enough, one of them stabbed me in the foot (injury number 2) and then sat on me(black eye, injury number 3).

Suffice to say plenty of fun was had by all, especially me, in a most unexpected way. Funny how things seem to come in patches, complicating stuff unnecessarily. Or maybe it's me that complicates things. Anyway; it was good.

The next morning was a bit like a scene from Morning of the Living Dead, and the obligatory prank was played on Spuds, by hiding his car in the field. And now, we've all gone our separate ways, and I just about feel human again. My fourth injury appears to be classic tenosynivitis, of my left great toe extensors. Part of me is in thrall of the classic signs, most of me wishes it wasn't so fucking painful.

Anyway - Tatania, Oberon, Bottom, Jolly Green Giant, Michael Knight (and Kitt) and all the others, Lemon and non-citric alike. I salute you all. We may get older, but damn, we still know how to burn one down. (although we haven't worked out how to recover afterwards)

Thursday, May 10, 2007

I actually don't have a great deal more to say about the noble practitioners of pharma; I'm just not sure they're feeling the love enough. And, to be fair, I'm sure they've spent more time correcting my mistakes than vice versa.

So, that's done. My great friend's wedding is only days away, and I'm stressing about it; I know there's shit I need to do, but I'm too agitated to think straight. In case you're wondering why there are no insightful, or cutting, remarks regarding the world of medicine, and my tiny orbit within it, I'm on leave.For those of you who just have to have something to mull over, I'm increasingly worried about what's going to happen in August, when the fucking train wreck that is MMC / MTAS will be unveiled in the halogen lights of patient care, and docs with no jobs.

(Yes, I know that's a shit analogy; I wanted to say 'comes home to roost', but that made even less sense)

On the positive side, while getting drunk, probably excessively, over the Bank Holiday weekend, and ranting at anyone who'd listen, I became re-acquainted with one of my favourite people. There seem to be people around whom I orbit in weird ways, only crossing paths very briefly.

Sometimes, that's fine - we can't all be bosom buddies. But there are one or two who I always wish I could see more of. This weekend's meeting is of the latter category, and I'm seeing them again tonight. This can only up the world's net happiness score - and that's gotta be good right? (Unless of course I piss them off enough to counteract it... shit, I hadn't thought of that)

Please be aware that Shroom does not condone heavy drinking. It's not actually anywhere near as big and clever as he thinks it is, but i think I've passed comment on this before. I'm guessing if you care enough you can find it in the archive.

Expect gory details of this evening's entertainment, and 'What Shroom Got Up To In A Field In Kent' next time out.

Wednesday, May 09, 2007

The storm has passed; the bad news that has haunted me these past few days is getting better. If that makes sense.

I haven't told anyone else about it; they've all got their own problems, and I'm not sure I was strong enough to do it anywhere but here. I'm sure it's not emotionally healthy to bottle shit up, but it's sometimes I can keep from being overwhelmed.

Whatever; things could have gone really down the shitter, and they haven't. Sometimes you have to cling to the little details.

I think I might have some good news, too, but more of that later - probably.

Friday, May 04, 2007

This post could be almost anything; I might, at a later date muse about the Doctor-Nurse dynamic, specifically as applied to Shroom.I could simply write how great nurses are... that would surely be too simple, and runs the risk of being condescending.

However, and this is in no way related to a realisation brought on by a comment made to me by a valued colleague while we studied an archaic looking piece of equipment at South Coast General, I would like to say how much I've enjoyed working in my last post, specifically because of the Nursing Staff there and my relationship with them. They have stood by me, even when I didn't have a clue, and when the toys were firmly ejected from the pram, and they drank beer with me, then picked me up afterwards.

Well, I've moved hospitals... this is in general a pain in the arse, for a whole host of reasons. This is what I wanted to blog about, for want of a better, more pertinent thing.

But today I had some bad news... The details should remain obscure. Although it's my bad news, as it were, it belongs to other people more than it does me; and they have no real desire to see it plastered over here. Suffice to say it has knocked me for six a little.

Pain sure brings out in the best in people, doesn't it? Thus spake the philosopher Zimmerman. I'm not sure he was right. I guess it focuses everyone. When something like this happens, you wonder. Is this my fault? Could I have done something different, something that would have made a difference? I think the answer is mostly "no"; but I wonder... it continues to show my selfish side to the max.

This is someone else's pain, and around it are circles of despair, each one a little further removed from the next. Where mine is depends on who's pain it was to start with. I know it's not about me, but somehow I still find a way to make it about me.

Time after time, I have put things off, signing up to the theory of 'there's always more time' I'm sure you all know it, but usually there isn't. Right now, I have never felt more regret for the lazy way I have abandoned my life for my work. Somehow it feels like I have abandoned more than just my own...

Legal Disclaimer

All the patient details reperesented here are composite. The details of my movements and activities are as accurate as I can make them, but the rest is largely made up. The Shroom's opinions do not represent those of the NHS at large, and should not be taken as a substitute for seeing a proper doctor. Lastly, and for what its worth, all the material herein is copyright The Shroom, and I reserve the right to send large bald men to your place of residence if you reproduce it without permission.